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Posterior iris-claw aphakic intraocular lens implantation and Descemet membrane endothelial keratoplasty
  1. Johannes Gonnermann,
  2. Anna-Karina B Maier,
  3. Matthias K J Klamann,
  4. Tobias Brockmann,
  5. Eckart Bertelmann,
  6. Antonia M Joussen,
  7. Necip Torun
  1. Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Johannes Gonnermann, Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany; johannes.gonnermann{at}


Purpose To evaluate clinical outcomes and complications after Descemet membrane endothelial keratoplasty (DMEK) and posterior iris-claw aphakic intraocular lens (IOL) implantation.

Methods This prospective cohort study comprised seven consecutive eyes (seven patients) without adequate capsular support and bullous keratopathy undergoing posterior iris-claw aphakic IOL implantation and DMEK. Corneal transparency, central corneal thickness, endothelial cell density, visual outcomes and complication rates were measured during the follow-up.

Results The iris-claw IOLs were inserted during an IOL exchange in three eyes, and as a secondary IOL implantation in one aphakic eye during DMEK procedure. Three eyes had IOL exchange prior to secondary DMEK. Mean follow-up was 7 months (range 3–14 months). The final best spectacle-corrected visual acuity improved significantly (0.33±0.31 logMAR) compared with the preoperative best spectacle-corrected visual acuity (1.84±0.90 logMAR). The mean endothelial cell loss was 24.8% over the follow-up. Complications included graft dislocation in four eyes; which could be easily reattached with a rebubbling procedure. No graft failures, no cases of pupillary block glaucoma and no IOL dislocations were encountered.

Conclusions DMEK and retropupillar iris-claw IOL implantation provide good visual outcomes with a fast visual recovery and appear to be a feasible method for the management of bullous keratopathy but with higher graft detachment rates.

Trial registration number NCT02020044.

  • Cornea
  • Anterior chamber

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